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ObjectiveTo investigate the effect of acute submaximal exercise, based on the spinal cord injury (SCI) Exercise Guidelines, on cognition and brain-derived neurotrophic factor (BDNF) in people with SCI.DesignEight adults (7 males) with traumatic SCI volunteered in this pre-registered pilot study. In randomized order, participants completed submaximal intensity arm cycling (60% of measured peak-power output at 55–60 rpm) for 30 min or time-matched quiet rest (control condition) on separate days. Blood-borne BDNF was measured in serum and plasma at pre-intervention, 0 min and 90 min post-intervention. Cognition was assessed using the Stroop Test and Task-Switching Test on an electronic tablet pre- and 10 min post-intervention.ResultsSubmaximal exercise had no effect on plasma [F(2,12) = 1.09; P = 0.365; η² = 0.069] or serum BDNF [F(2,12) = 0.507; P = 0.614; η² = 0.024] at either 0 min or 90 min post-intervention. Similarly, there was no impact of exercise on either Stroop [F(1,7) = 2.05; P = 0.195; η² = 0.065] or Task-Switching performance [F(1,7) = 0.016; P = 0.903; η² P = 0.011) and serum BDNF (r = 0.799; P = 0.023). However, there was not relationship between years since injury and the BDNF response to exercise.ConclusionsAcute guideline-based exercise did not increase BDNF or improve aspects of cognition in persons with SCI. This work establishes a foundation for continued investigations of exercise as a therapeutic approach to promoting brain health among persons with SCI.

Individuals with spinal cord injury (SCI) may experience cardiovascular, musculoskeletal and organ function dysregulation. Sequelae include reduced catecholamine secretion and attenuated immune responses which may impact exercise-induced leukocytosis. The purpose of this study was to characterize major leukocyte subtypes following 30 minutes of acute, submaximal aerobic exercise, in line with updated international SCI exercise guidelines for adults. It was hypothesized that exercise would increase major leukocyte subtypes when compared to fasted baseline. Eight participants with SCI (incomplete n = 6; complete n = 2) completed a 30-minute bout of aerobic exercise on an arm cycle ergometer at 60% of their peak power output followed by 90 minutes of recovery, or a 2-hour seated control condition, in a randomized crossover design, separated by 7-14 days. Blood samples were taken at baseline, post exercise, and 90 minutes after exercise (with time matched control). Leukocyte subtypes were analyzed via flow cytometry and plasma catecholamines by ELISA. Several leukocytes increased from pre- to post-exercise (time X condition interaction; all P < 0.05; mean ± SD), including CD3+ Lymphocytes (19 ± 16%), CD4+ T helper (16 ± 13%), CD8+ T cytotoxic (24 ± 23%), CD3+/CD56+ natural killer T (31 ± 34%), and CD3-/CD56+ natural killer (63 ± 82%). CD16+/CD14dim monocytes decreased by 27 ± 38% following exercise to 90 minutes post-exercise. No changes were observed for catecholamines for either condition. Thirty minutes of acute submaximal aerobic exercise sufficiently increased most lymphocyte subsets with effector functions, while leading to decreased proinflammatory monocytes during the recovery phase. This exercise duration and intensity appear to be an appropriate option for modulating circulating immune cells in individuals with SCI., Jan van der Scheer is based in The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK.

Supplemental material, sj-pdf-1-nnr-10.1177_15459683211017504 for Effects of a Tailored Physical Activity Intervention on Cardiovascular Structure and Function in Individuals With Spinal Cord Injury by Alexandra M. Williams, Jasmin K. Ma, Kathleen A. Martin Ginis and Christopher R. West in Neurorehabilitation and Neural Repair

Supplemental material, sj-pdf-1-nnr-10.1177_15459683211017504 for Effects of a Tailored Physical Activity Intervention on Cardiovascular Structure and Function in Individuals With Spinal Cord Injury by Alexandra M. Williams, Jasmin K. Ma, Kathleen A. Martin Ginis and Christopher R. West in Neurorehabilitation and Neural Repair

Background The majority of people with spinal cord injury (SCI) in the United States are not meeting the recommended guidelines for regular physical activity. Behavior change techniques (eg, goal setting and action planning) that are framed within the principles of the social cognitive theory (self-efficacy and self-regulation) have the potential to enhance physical activity behavior. Objective The aim of the study was to develop and test the usability of an electronic learning (e-learning) program for improving social cognitive factors related to physical activity behavior among people with SCI. Methods The program was created through an iterative process of development and refinement, using a modification of a similar methodology used to develop evidence-informed guidelines in health promotion for people with disabilities (Guidelines, Recommendations, and Adaptations Including Disability; GRAIDs framework). The study included 4 phases: (1) initial product creation, (2) national survey, (3) expert review, and (4) usability testing. Usability testing included both quantitative and qualitative data collection and analyses. Results The review of the program by an expert panel (n=5) and the results from a national survey (n=142) led to several refinements. Usability testing demonstrated that the program could be completed in a timely manner ( Conclusions This study incorporated an evidence-based framework for developing a brief 30-min e-learning program for increasing the physical activity behavior among people with SCI. The Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling (e-STORIES) program could be completed in a timely manner and was reported by participants as valuable and useful for enhancing intent-to-perform physical activity in individuals with SCI. The program has the potential to be applied in a variety of settings, but feasibility testing is required before implementing in a larger trial.

Background: Physical activity (PA) must be performed regularly to accrue health benefits. However, the majority of manual wheelchair users do not meet PA recommendations. Existing community-based PA programs for manual wheelchair users appear to work, but effect sizes are small and retention is low. Existing PA programs may not fully implement some psychosocial factors that are strongly linked with PA (eg, autonomy). The use of peers and mobile phone technology in the Smartphone Peer PA Counseling (SPPAC) program represents a novel approach to cultivating a PA-supportive environment for manual wheelchair users. Objective: The primary objective is to compare change in objective PA between the experimental (SPPAC) and control groups from baseline to postintervention (10 weeks) and follow-up (3 months). Changes in and relationships between subjective PA, wheelchair skills, motivation, self-efficacy (for overcoming barriers to PA for manual wheelchair use), satisfaction of psychological needs for PA, and satisfaction with PA participation will be explored (secondary outcome). Program implementation will be explored (tertiary objective). Methods: A total of 38 community-living manual wheelchair users (≥18 years) will be recruited in a randomized controlled trial (RCT). Participants in both the control and experimental groups will receive existing PA guidelines. Participants in the experimental group will also receive the SPPAC program: 14 sessions (~30 min) over a 10-week period delivered by a peer trainer using a mobile phone. PA activities will be based on individuals’ preferences and goals. Implementation of important theoretical variables will be enforced through a peer-trainer checklist. Outcomes for objective PA (primary) and subjective PA, wheelchair skills, motivation, self-efficacy, satisfaction of psychological needs, and satisfaction with participation will be collected at three time points (baseline, postintervention, follow-up). Multiple imputations will be used to treat missing data. A mixed-model ANCOVA will be conducted, controlling for covariates (primary and secondary objectives). The strength and direction of the relationships between the primary and secondary outcomes will be explored (secondary objective). Descriptive and content analysis will be used to appraise program implementation (tertiary objective). Results: Funding has been obtained from the Craig Neilsen Foundation and the Canadian Disability Participation Project, with additional funds being sought from the Canadian Institute for Health Research and Fonds de Recherche du Quebec-Sante. Pilot evaluation of intervention implementation is currently underway, with enrollment anticipated to begin early 2018. Conclusions: There may be substantial benefits for the SPPAC program including limited burden on health care professionals, decreased barriers (eg. accessibility, transportation), development of peer social supports, and potential cost savings related to physical inactivity. Before conducting a large and expensive multisite RCT within a small heterogeneous population of manual wheelchair users, a pilot study affords a prudent step to establishing an adequate study protocol and implementation strategies. Trial Registration: ClinicalTrials.gov NCT02826707; https://clinicaltrials.gov/ct2/show/NCT02826707 (Archived by WebCite at http://www.webcitation.org/6pqIc14dU) [JMIR Res Protoc 2017;6(4):e69]

Background: Canada's 24-Hour Movement Guidelines for Children and Youth provide daily recommendations for physical activity (PA), screen time, and sleep for optimal health. The appropriateness of such guidelines for youth with disabilities remains unknown. Objective: To cross-sectionally examine the 24-h movement behaviours and guideline adherence in youth (ages 12–21 years) with physical and sensory disabilities. Methods: 54 youth with physical and sensory disabilities completed two, 24-h recalls to assess PA, sedentary behaviour, and sleep. Descriptive statistics were used to analyze behavioural patterns and guideline adherence. Gender and age differences were tested using analyses of variance and logistic regressions. Results: 55.5%, 13.0%, and 53.7% of the sample met the individual guidelines for PA, sedentary behaviour, and sleep, respectively. 3.7% of the sample met all three movement guidelines. No significant gender or age differences in guideline achievement were found. Over a 24-h period, youth spent 77 (59) minutes engaging in moderate to vigorous PA, 252 (120) minutes engaging in sedentary activity, and 546 (90) minutes sleeping. Boys reported significantly more time (adjusted Mdifference = 11 min) playing passive video games than girls. Conclusion: Overall, our sample of youth with physical and sensory disabilities falls far short of meeting the Canadian 24-Hour Movement Guidelines for Children and Youth. The low proportion of youths’ time spent engaging in sport and active play is concerning, highlighting the importance of creating access to these types of PA experiences for this population. Future population-based research is needed among children and youth with all types of disabilities to build an evidence-base of their movement behaviours. Refereed/Peer-reviewed

L’activitat física (AF) ha demostrat tenir una gran quantitat d’efectes positius sobre la salut, el benestar i la qualitat de vida de les persones amb discapacitat. Amb tot, diversos estudis han trobat que les persones amb discapacitat participen en AF en menor mesura que la població general. Davant d’aquesta situació, el disseny i desenvolupament d’intervencions centrades en l’increment i la millora de la participació en AF de les persones amb discapacitat ha de ser un objectiu prioritari de les polítiques de salut pública. L’objectiu general de la present tesi doctoral és estudiar l’AF de l’alumnat amb discapacitat de les universitats espanyoles i els seus correlats sociodemogràfics, psicosocials i de l’entorn, per tal de generar un coneixement valuós per al disseny i el desenvolupament de polítiques universitàries de salut centrades en el foment d’estils de vida actius en aquest col·lectiu. Per fer-ho, s’utilitzen de forma conjunta la Teoria de la Conducta Planejada i la teoria socioecològica de promoció de la salut. Els i les participants d'aquest estudi transversal es van reclutar a través dels serveis d’atenció a la discapacitat de les universitats espanyoles. Un total de 1.264 estudiants universitaris amb diferents discapacitats (física, trastorn mental, sensorial, malaltia crònica o múltiples discapacitats) van ser enquestats. Els instruments utilitzats per a la recollida de dades van ser l’International Physical Activity Questionnaire-Short Form, la versió reduïda en espanyol del qüestionari Barriers to Physical Activity Questionnaire for People with Mobility Impairments i un qüestionari de Teoria de la Conducta Planejada en l’AF. Les dades recollides es van analitzar utilitzant diversos anàlisis estadístics, com ara proves no paramètriques, anàlisi factorial confirmatòria, regressió múltiple o anàlisi del camí. Els resultats obtinguts indiquen que un percentatge molt alt (63,1%) de l’alumnat no compleix cap de les recomanacions d’AF de l’Organització Mundial de la Salut. A més, l’alumnat amb múltiples discapacitats, malalties cròniques, discapacitat adquirida, l’alumnat més major, l’alumnat amb obesitat i les dones reporten menys AF que els seus homòlegs. Les barreres intrapersonals, com ara el dolor, la fatiga, la falta de motivació i la falta de confiança són les més importants, especialment per a les dones, l’alumnat amb múltiples discapacitats, l’alumnat amb un major grau de discapacitat i l’alumnat més major. Les barreres organitzacionals, com la falta de programes d’AF adaptada i el seu cost econòmic o la falta de formació dels tècnics de les instal·lacions esportives, també destaquen com a factors rellevants, especialment en l’alumnat amb múltiples discapacitats, discapacitat física o un major grau de discapacitat. Les barreres interpersonals, com ara la inactivitat dels amics i la inactivitat de la família afecten més l’alumnat més major i l’alumnat amb múltiples discapacitats. Finalment, les barreres comunitàries, com ara les voreres inaccessibles o els clots als carrers, afecten més l’alumnat amb múltiples discapacitats, discapacitat física o major grau de discapacitat. També cal destacar que l’autoeficàcia i la controlabilitat s’han mostrat com a predictors directes de l’AF, amb les dones presentant puntuacions més baixes en ambdós constructes. A més, les intencions i les barreres socioecològiques també s’han mostrat com a predictor directe de l’AF, mentre que alguns nivells socioecològics de barreres s’han revelat com a predictors de l’autoeficàcia i de la controlabilitat. En conclusió, la present tesi doctoral aporta un coneixement valuós per al desenvolupament de polítiques de salut a les universitats dirigides a l’alumnat amb discapacitat. Els resultats obtinguts poden ser un punt de partida per als serveis d’esports i els serveis d’atenció a la discapacitat d’aquestes institucions per tal de dissenyar i portar a terme intervencions de canvi de comportament en AF que amplien i milloren l’accés d’aquest col·lectiu als beneficis d’un estil de vida actiu. Physical activity (PA) has been shown to have positive effects on the health, well-being and quality of life of people with disabilities. However, several studies have found that people with disabilities engage in PA to a lesser extent than the general population. In the light of the foregoing, the design and development of interventions focused on increasing and improving PA participation of people with disabilities should thus be a major goal of public health policies. The overall purpose of this doctoral thesis is to study the PA of Spanish university students with disabilities and its sociodemographic, psychosocial and environmental correlates, in order to generate valuable knowledge for the design of university health policies aiming to encourage physically active lifestyles among this population. To do so, the Theory of Planned Behaviour and the social ecological theory of health promotion are used. Participants for this cross-sectional survey study were recruited through the disability care services of Spanish universities. A total of 1264 university students with different disabilities (physical, mental disorder, sensory, chronic illness or multiple disabilities) were surveyed. The International Physical Activity Questionnaire-Short Form, the reduced Spanish version of the Barriers to Physical Activity for People with Mobility Impairments and a Theory of Planned Behaviour questionnaire were used for data collection. Different statistical analyses such as non-parametric tests, confirmatory factor analysis, multiple regression and path analysis were used for data analysis. A high percentage (63.1%) of university students with disabilities do not meet any of the World Health Organization PA recommendations. Moreover, students with multiple disabilities, chronic illnesses, acquired disabilities, older students, obese students and women report less PA than their counterparts in the different PA domains. Intrapersonal barriers such as pain, fatigue, lack of motivation and lack of confidence have been found to be the most important, especially for women, students with multiple disabilities, students with higher disability grade and older students. Organizational barriers such as the lack of adapted PA programs and their economic cost or the lack of training of staff at fitness centres also stand out as relevant factors, especially in students with multiple disabilities, physical disability or higher disability grade. Interpersonal barriers such as the inactivity of friends and family affect older students and students with multiple disabilities to a greater extent. Finally, community barriers, such as inaccessible sidewalks or potholes in the streets, are more relevant for students with multiple disabilities, physical disability and higher disability grades. It is also relevant to highlight that self-efficacy and controllability have been shown as direct predictors of PA, with women scoring lower than men on both constructs. In addition, intentions and social ecological barriers have been shown as direct predictors of PA as well, and different social ecological levels of barriers have been revealed as self-efficacy and controllability predictors. In conclusion, the present doctoral thesis provides valuable knowledge for developing university health policies addressed to students with disabilities. The results obtained could be a starting point for the sports services and disability care services of these institutions in order to design and implement PA behaviour change interventions that increase and improve the access of this population to the benefits of an active lifestyle.