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The aim of this study was to determine changes in physical activity, nutrition, sleep behaviour and body composition in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application (app). A 12-week pre-post intervention study was performed, starting with a 1-week control period. Physical activity and sleep behaviour were continuously measured with a Fitbit charge 3. Self-reported nutritional intake, body mass and waist circumference were collected. Pre-post outcomes were compared with a paired-sample t-test or Wilcoxon signed-rank test. Fitbit data were analysed with a mixed model or a panel linear model. Effect sizes were determined and significance was accepted at p <.05. Thirty participants completed the study. No significant changes in physical activity (+1.5 √steps) and sleep quality (–9.7 sleep minutes; −1.2% sleep efficiency) were found. Significant reduction in energy (–1022 kJ, d = 0.71), protein (–8.3 g, d = 0.61) and fat (–13.1 g, d = 0.87) intake, body mass (–2.2 kg, d = 0.61) and waist circumference (–3.3 cm, d = 0.80) were found. Positive changes were found in nutritional behaviour and body composition, but not in physical activity and sleep quality. The WHEELS app seems to partly support healthy lifestyle behaviour. Healthy lifestyle promotion is crucial, especially for wheelchair users as they tend to show poorer lifestyle behaviour despite an increased risk of obesity and comorbidity. The WHEELS lifestyle app seems to be a valuable tool to support healthy nutrition choices and weight loss and to improve body satisfaction, mental health and vitality. [ABSTRACT FROM AUTHOR]

(1) To estimate the proportion of Dutch wheelchair users with spinal cord injury (SCI) who meet different SCI exercise guidelines; (2) to evaluate which demographic and lesion characteristics are associated with meeting these guidelines; (3) whether meeting these guidelines is associated with physical fitness and health. Based on the PASIPD questionnaire items, participants were allocated to meeting two SCI aerobic exercise guidelines, which differ in exercise load. Differences in personal, lesion, fitness, and health characteristics between groups were tested with a one-way ANOVA. Multiple regression analyses were performed to evaluate if meeting guidelines was associated with better fitness and health. Statistical significance was accepted at p < 0.05. Of the 358 included participants, 63.1% met at least one aerobic exercise guideline. Being female, older age, having tetraplegia, and lower educational level were associated with a lower likelihood to meet the aerobic exercise guidelines. Meeting aerobic exercise guidelines showed a positive association with all respiratory and exercise capacity parameters. Limited associations were found between meeting exercise guidelines and health. Meeting exercise guidelines was associated with better respiratory functions and exercise capacity with additional fitness and some body composition benefits in higher exercise activity levels. Meeting SCI exercise guidelines are associated with better respiratory functions and exercise capacity with additional fitness and body composition benefits when higher exercising at higher activity levels, emphasizing the value and importance of regular exercise in individuals with SCI. [ABSTRACT FROM AUTHOR]

Background: Heart rate (HR) is an important and commonly measured physiological parameter in wearables. HR is often measured at the wrist with the photoplethysmography (PPG) technique, which determines HR based on blood volume changes, and is therefore influenced by blood pressure. In individuals with spinal cord injury (SCI), blood pressure control is often altered and could therefore influence HR accuracy measured by the PPG technique. Objective: The objective of this study is to investigate the HR accuracy measured with the PPG technique with a Fitbit Charge 2 (Fitbit Inc) in wheelchair users with SCI, how the activity intensity affects the HR accuracy, and whether this HR accuracy is affected by lesion level. Methods: The HR of participants with (38/48, 79%) and without (10/48, 21%) SCI was measured during 11 wheelchair activities and a 30-minute strength exercise block. In addition, a 5-minute seated rest period was measured in people with SCI. HR was measured with a Fitbit Charge 2, which was compared with the HR measured by a Polar H7 HR monitor used as a reference device. Participants were grouped into 4 groups--the no SCI group and based on lesion level into the T1 (cervical) group. Mean absolute percentage error (MAPE) and concordance correlation coefficient were determined for each group for each activity type, that is, rest, wheelchair activities, and strength exercise. Results: With an overall MAPEall lesions of 12.99%, the accuracy fell below the standard acceptable MAPE of -10% to +10% with a moderate agreement (concordance correlation coefficient=0.577). The HR accuracy of Fitbit Charge 2 seems to be reduced in those with cervical lesion level in all activities (MAPEno SCI=8.09%; MAPET1=20.43%). The accuracy of the Fitbit Charge 2 decreased with increasing intensity in all lesions (MAPErest=6.5%, MAPEactivity=12.97%, and MAPEstrength=14.2%). Conclusions: HR measured with the PPG technique showed lower accuracy in people with SCI than in those without SCI. The accuracy was just above the acceptable level in people with paraplegia, whereas in people with tetraplegia, a worse accuracy was found. The accuracy seemed to worsen with increasing intensities. Therefore, high-intensity HR data, especially in people with cervical lesions, should be used with caution. [ABSTRACT FROM AUTHOR]

Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of "RehabMove" congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration. This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress. The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate "human and technology asset management" at both individual and organization levels and over the lifespan. With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention. Continued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences. Notions from "human and technology asset management and ergonomics" are fundamental to rehabilitation practice and research. The rehabilitation concept will further merge into general health care and the quality there-off. [ABSTRACT FROM AUTHOR]

Background: Maintaining a healthy lifestyle is important for wheelchair users' well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) are highly prevalent in peo­ple with spinal cord injury (SCI). Electrical stimulation (ES) activates muscles and might reduce risk factors. Our objectives were to study and compare the effects of two duty cycles during 3 h of ES-induced gluteal and hamstring activation on interface pressure distribution in sitting individuals with SCI and study the usability of a newly developed electrode garment (ES shorts). Ten individuals with SCI participated in this study, in which two ES protocols with different duty cycles (1:1 s vs 1:4 s on-off) were applied in counterbalanced order using a custom-made garment with built-in electrodes. Outcome variables included interface pressure of the ischial tuberosities (ITs) and pressure gradient. A questionnaire was used to determine usability of the ES shorts. In both protocols, ES caused a significant decrease in average IT pressure compared with rest (no ES); on average, 35% for protocol 1:4 and 13% for protocol 1:1. The ES on-off duty cycle of protocol 1:4 showed less muscle fatigue. In general, participants scored the usability of the ES shorts as satisfactory. In this study, the application of ES resulted in a significant decrease in IT pressure. The ES on-off duty cycle of 1:4 s is recommended because of the less fatiguing effect. ES of the hamstrings and gluteal muscles might be a promising method in preventing PUs, but further study is needed. [ABSTRACT FROM AUTHOR]

Measuring interface pressure (IP) is one way to characterize cushion performance in the clinic and laboratory. This study explored how the presence of four commercially available IP mats affected IP on and immersion of two buttocks models. We loaded seven cushions with each buttocks model and captured pressure data using FSA sensors (Vista Medical Ltd; Winnipeg, Manitoba, Canada). Analysis was performed to compare pressure magnitude and immersion. Overall, both pressure magnitude and immersion changed after mat introduction. A significant interaction existed between cushion and mat condition and cushion and model for all variables. Introducing an IP mat to the model-cushion interface alters the loading on the cushion. The mats bridged the contours of the model, causing a change in IP at the locations studied. Although immersion was statistically different between mat conditions, the magnitude of the difference was less than 1 mm once we accounted for the thickness of the mats. The significance of the cushion-mat interaction indicates that the mat effect differed across cushion design. Clinical and research users of pressure mats should consider the effect of mat presence, the effect of model design, and mat and buttocks interactions with cushions for successful use. [ABSTRACT FROM AUTHOR]