45 research outputs found

    Exploring Obesity Among Wheelchair Users: BMI vs Body Compostion

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    Author(s): Katherine Froehlich-Grobe, PhD1 & Richard A. Washburn, PhD2 Affiliations: 1 University of Texas School of Public Health, Dallas Regional Campus, 2 Center for Physical Activity and Weight Management, University of Kansas Purpose: Body mass index (BMI) is commonly used to indicate weight status but has been critiqued for being insensitive to body composition. Americans with disabilities have significantly higher obesity rates than those without when BMI has been used as the indicator of weight status. Examining obesity prevalence based on body composition among this group is warranted. As the life expectancy of those with disabilities has increased to approximate that of the general population, so too has chronic disease morbidity and mortality for which being overweight is a risk factor such as hypertension, hyperlipidemia, diabetes, and cardiovascular diseases. Further, evidence suggests that those with disabilities experience these conditions at earlier ages than the general population and obesity is likely a contributing factor. Approximately 1 in 5 Americans experience disability, and national estimates indicate that between 44%-62% of those with disability experience impaired mobility. Mobility impairments severe enough to necessitate wheelchair use often result in substantial physical changes that may alter body composition. The purpose of this study was to assess body composition, including body fat using dual absorptiometry x-ray (DXA) among wheelchair users as compared to BMI. Method: Conducted DXA scans on 42 wheelchair users. Results: Participants were predominantly white (86%) women (55%), with an average age of 46.1 + 13.7 years and had lived an average of 25.1 + 15.5 years with their impairment. Mobility impairments were due to spinal cord injury (41.9%), cerebral palsy/spina bifida (23.0%),Multiple Sclerosis (7.0%), post-polio (7%), or other causes (21.4%) such as lupus, amputation, or orthopedic impairment. The average body fat percent for men and women with a BMI in the normal weight range (18.5 – 24.99 kg/m2) was 28.6 + 7.1% and 41.2 + 0.6% respectively, and these values increased to substantially in both sexes at every BMI range (overweight 34.2 + 3.1%, 48.9 + 5.9%; obese 42.7 + 4.9%, 55.0 + 4.4% for men and women respectively) . Thus, wheelchair users with a normal BMI had a percentage body fat that would be indicative of obesity in individuals without impairment. Conclusions: These results highlight the need to further examine weight status and body composition in wheelchair users and the health risks that alterations in weight and body composition pose for this group. Learning objectives 1. This presentation will help audience members to understand the complexities of determining weight status among those with disabilities in terms of body composition. 2. This presentation will guide audience members to think about how alterations in body composition may affect the health status of those with disabilities

    Recruitment issues in a randomized controlled exercise trial targeting wheelchair users

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    This paper describes recruitment challenges and lessons learned in conducting a randomized controlled exercise trial in the absence of direct access to a clinical population. One hundred thirty-five wheelchair users were enrolled in a home and community-based intervention to promote exercise adoption and maintenance. Over 44 months of recruitment, 355 individuals inquired about the study and 323 completed the screening process. Nearly half were determined ineligible (150/323, 46.4%), typically due to having restricted arm movement, cognitive impairment, or medical conditions that are contraindicated for unsupervised exercise. Respondents cited paid media advertisements and recruitment materials placed in health care providers’ offices most frequently as being how they learned about the study. RCT participant recruitment, particularly in the absence of direct access to a clinical population, required far more time and resources than anticipated to achieve sufficient enrollment. Nurturing relations with key gatekeepers, creating a visible public profile, and maintaining ongoing recruitment activities were essential to success

    Truth Be Told: Evidence of Wheelchair Users’ Accuracy in Reporting Their Height and Weight

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    Objectives To examine whether wheelchair users’ self-reports of height and weight differed significantly from direct measurements and whether weight category classifications differed substantially when based on self-reported or measured values. Design Single group, cross-sectional analysis. Analyses included paired t tests, chi-square test, analysis of variance, and Bland-Altman agreement analyses. Setting A university-based exercise lab. Participants Community-dwelling wheelchair users (N=125). Interventions Not applicable. Main Outcome Measure Participants’ self-reported and measured height, weight, and body mass index. Results Paired t tests revealed that there were significant differences between wheelchair users’ self-reported and measured values for height (difference of 3.1±7.6cm [1.2±3.0in]), weight (−1.7±6.5kg [−3.6±14.2lb]), and BMI (−1.6±3.3). These discrepancies also led to substantial misclassification into weight categories, with reliance on self-reported BMI underestimating the weight status of 20% of the sample. Conclusions Our findings suggest that similar to the general population, wheelchair users are prone to errors when reporting their height and weight and that these errors may exceed those noted in the general population

    Exercise for Everyone: A randomized controlled trial of Project Workout On Wheels in promoting exercise among wheelchair users

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    This is the author's accepted manuscript. Made available by the permission of the publisher.Objective To compare the effectiveness of two home-based behavioral interventions to promote wheelchair users exercise adoption and maintenance over 12 months. Design Randomized controlled trial, with participants stratified into groups based on disability type (stable, episodic, progressive) and support partner availability. Setting Exercise occurred in participant preferred locations (e.g., home, recreation center), with physiological data collected at the university-based exercise lab. Participants One hundred twenty-eight inactive wheelchair users (64 women) with sufficient upper arm mobility for arm-based exercise enrolled. Participants on average were 45 years old, lived with their impairment for 22 years, with spinal cord injury (46.1%) most commonly reported as causing mobility impairment. Interventions Both groups received home-based exercise interventions. The staff-supported group (n= 69) received intensive exercise support, while the self-guided group (n= 59) received minimal support. Both received exercise information, resistance bands, instructions to self-monitor exercise, regularly-scheduled phone calls, and handwritten cards. Main Outcome Measures The primary outcome derived from weekly self-reported exercise. Secondary outcomes included physical fitness (aerobic/muscular) and predictors of exercise participation. Results The staff-supported group reported significantly greater exercise (~ 16 minutes/week) than the self-guided group over the year (t=10.6, p=0.00), with no significant between group difference in aerobic capacity (t=0.76, p=0.45) and strength (t=1.5, p=0.14). Conclusions Although the staff-supported group reported only moderately more exercise, the difference is potentially clinically significant as they also exercised more frequently. The staff-supported approach holds promise for encouraging exercise among wheelchair users, yet additional support may be necessary to achieve more exercise to meet national recommendations

    Effectiveness and Feasibility of the Workout on Wheels Internet Intervention (WOWii) for Individuals With Spinal Cord Injury: A Randomized Controlled Trial

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    STUDY DESIGN: Randomized-controlled trial (RCT) with immediate intervention (IMM) and wait-list control (WLC) groups; WLC participants received the intervention during delivery to subsequent cohorts. OBJECTIVES: Investigate the effectiveness and feasibility of a virtually-delivered exercise intervention. SETTING: Home and community. METHODS: A total of 168 middle-aged (49.6 [12.3] years old) men (57%) and women (43%) who lived an average 15.5 (12.3) years with spinal cord injury (SCI) participated. The 16-week program provides users (a) website access with exercise information, resources, and 16 skill-building modules; (b) virtual 60-minute, group-based weekly meetings; and (c) a starter package of exercise equipment. Primary outcomes included subjective physical activity (IPAQ) and objective exercise (Polar A300 wrist-based activity monitor and H7 heart rate strap). Secondary outcomes included fitness indices during a maximal arm crank test, plus self-reported exercise barriers, exercise self-efficacy, and goal-directed thinking. RESULTS: RCT results indicate significant between group differences in participants\u27 self-reported weekly time spent in vigorous-intensity PA and goal directed thinking but not for fitness changes. Data combined for IMM and WLC participants from Polar monitoring show participants performed 150 min per week of aerobic exercise plus reported significantly greater time spent in moderate-PA, vigorous-PA, self-efficacy for exercise and nutrition, goal directed thinking, and exercise barriers. Oxygen uptake (V̇O CONCLUSION: This virtually-delivered program offers a promising approach to increase exercise among those with SCI and may help participants perceive fewer motivational barriers and greater self-efficacy

    Children with cerebral palsy in Ghana: malnutrition, feeding challenges, and caregiver quality of life

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    AIM: To assess feeding difficulties and nutritional status among children with cerebral palsy (CP) in Ghana, and whether severity of feeding difficulties and malnutrition are independently associated with caregiver quality of life (QoL). METHOD: This cross-sectional survey included 76 children with CP (18mo-12y) from four regions of Ghana. Severity of CP was classified using the Gross Motor Function Classification System and anthropometric measures were taken. Caregivers rated their QoL (using the Pediatric Quality of Life Inventory Family Impact Module) and difficulties with eight aspects of child feeding. Logistic regression analysis explored factors (socio-economic characteristics, severity of CP, and feeding difficulties) associated with being underweight. Linear regression was undertaken to assess the relationship between caregiver QoL and child malnutrition and feeding difficulties. RESULTS: Poor nutritional status was common: 65% of children aged under 5 years were categorized as underweight, 54% as stunted, and 58% as wasted. Reported difficulties with child's feeding were common and were associated with the child being underweight (odds ratio 10.7, 95% confidence interval 2.3-49.6) and poorer caregiver QoL (p<0.001). No association between caregiver QoL and nutritional status was evident. INTERPRETATION: Among rural, low resource populations in Ghana, there is a need for appropriate, accessible caregiver training and support around feeding practices of children with CP, to improve child nutritional status and caregiver well-being. WHAT THIS PAPER ADDS: Malnutrition is very common among children with cerebral palsy in this rural population in Ghana. Feeding difficulties in this population were strongly associated with being underweight. Feeding difficulties were associated with poorer caregiver quality of life (QoL). Child nutritional status was not associated with caregiver QoL
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