Perceptions of High-Intensity Interval Training Among People With Spinal Cord Injury: A Mixed-Methods Analysis

in Adapted Physical Activity Quarterly

Click name to view affiliation

Joseph Peters Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Urbana, IL, USA

Search for other papers by Joseph Peters in
Current site
Google Scholar
PubMed Close
*
,
Kellie Halloran Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA

Search for other papers by Kellie Halloran in
Current site
Google Scholar
PubMed Close
https://orcid.org/0000-0003-1376-3069
,
Alexander Teague Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA

Search for other papers by Alexander Teague in
Current site
Google Scholar
PubMed Close
,
Emily Erlenbach Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA

Search for other papers by Emily Erlenbach in
Current site
Google Scholar
PubMed Close
,
Libak Abou Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

Search for other papers by Libak Abou in
Current site
Google Scholar
PubMed Close
https://orcid.org/0000-0001-6404-7623
,
Mariana Kersh Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA

Search for other papers by Mariana Kersh in
Current site
Google Scholar
PubMed Close
, and
Ian Rice Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA

Search for other papers by Ian Rice in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.1123/apaq.2022-0214
Keywords:
hand cycle; enjoyment; upper-body; exercise adherence
First Published Online:
22 Aug 2023
In Print:
Ahead of Print
Page Range:
1–23
Restricted access

This mixed-method project investigated how people with spinal cord injury perceive high-intensity interval training (HIIT). Using a recumbent hand cycle, 11 active men and 9 active women with spinal cord injury or related disease participated in a single HIIT and moderate-intensity continuous training (MICT) session. Following exercise, participants completed surveys assessing enjoyment, self-efficacy, and outcome expectations. Ten participants were randomly selected to participate in a semistructured interview to assess perceptions toward HIIT. Quantitative survey data revealed that participants trended toward enjoying HIIT over MICT (p = .06) with similar levels of self-efficacy and outcome expectations toward HIIT and MICT (p > .05). Qualitative data revealed that participants believed HIIT would enhance long-term physical and self-evaluative outcomes; several barriers emerged that could prevent widespread adoption among the general population with spinal cord injury. Results support HIIT as a viable exercise option, although research should begin exploring ways to remove HIIT-related barriers that people with spinal cord injury may encounter.

  • Collapse
  • Expand

Adapted Physical Activity Quarterly

Cover Adapted Physical Activity Quarterly

  • American College of Sports Medicine. (2017). ACSM’s exercise testing and prescription. Lippincott Williams & Wilkins.

  • Anderson, L., Sharp, G.A., Norton, R.J., Dalal, H., Dean, S.G., Jolly, K., . . . Taylor, R.S. (2017). Home‐based versus centre‐based cardiac rehabilitation. Cochrane Database of Systematic Reviews, 6, Article CD007130. https://doi.org/10.1002/14651858.CD007130.pub4

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Astorino, T.A., & Thum, J.S. (2018a). Interval training elicits higher enjoyment versus moderate exercise in persons with spinal cord injury. The Journal of Spinal Cord Medicine, 41(1), 77–84. https://doi.org/10.1080/10790268.2016.1235754

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Astorino, T.A., & Thum, J.S. (2018b). Within-session responses to high-intensity interval training in spinal cord injury. Disability and Rehabilitation, 40(4), 444–449. https://doi.org/10.1080/09638288.2016.1260648

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology, 4(3), 359–373. https://doi.org/10.1521/jscp.1986.4.3.359

    • Search Google Scholar
    • Export Citation

  • Bandura, A. (1997). Self-efficacy: The exercise of control. Worth Publishers.

  • Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143–164. https://doi.org/10.1177/1090198104263660

    • Search Google Scholar
    • Export Citation

  • Barbareschi, G., Cheng, T.J., & Holloway, C. (2018). Effect of technique and transfer board use on the performance of wheelchair transfers. Healthcare Technology Letters, 5(2), 76–80. https://doi.org/10.1049/htl.2017.0075

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

    • Search Google Scholar
    • Export Citation

  • Caetano, L.C.G., Pacheco, B.D., Samora, G.A.R., Teixeira-Salmela, L.F., & Scianni, A.A. (2020). Self-efficacy to engage in physical exercise and walking ability best predicted exercise adherence after stroke. Stroke Research and Treatment, 2020, Article 2957623. https://doi.org/10.1155/2020/2957623

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Carr, L.J., Karvinen, K., Peavler, M., Smith, R., & Cangelosi, K. (2013). Multicomponent intervention to reduce daily sedentary time: A randomised controlled trial. BMJ Open, 3(10), Article e003261. https://doi.org/10.1136/bmjopen-2013-003261

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Currie, K.D., Dubberley, J.B., McKelvie, R.S., & MacDonald, M.J. (2013). Low-volume, high-intensity interval training in patients with CAD. Medicine & Science in Sports & Exercise, 45(8), 1436–1442. https://doi.org/10.1249/MSS.0b013e31828bbbd4

    • Search Google Scholar
    • Export Citation

  • Dallmeijer, A.J., Ottjes, L., de Waardt, E., & van der Woude, L.H. (2004). A physiological comparison of synchronous and asynchronous hand cycling. International Journal of Sports Medicine, 25(8), 622–626. https://doi.org/10.1055/s-2004-817879

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Dallmeijer, A.J., Zentgraaff, I.D., Zijp, N.I., & van der Woude, L.H. (2004). Submaximal physical strain and peak performance in handcycling versus handrim wheelchair propulsion. Spinal Cord, 42(2), 91–98. https://doi.org/10.1038/sj.sc.3101566

    • PubMed
    • Search Google Scholar
    • Export Citation

  • de Groot, S., Kouwijzer, I., Baauw, M., Broeksteeg, R., & Valent, L.J. (2018). Effect of self-guided training for the HandbikeBattle on body composition in people with spinal cord injury. Spinal Cord Series and Cases, 4(1), 1–7. https://doi.org/10.1038/s41394-018-0103-6

    • Search Google Scholar
    • Export Citation

  • de Zepetnek, J.O.T., Pelletier, C.A., Hicks, A.L., & MacDonald, M.J. (2015). Following the physical activity guidelines for adults with spinal cord injury for 16 weeks does not improve vascular health: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 96(9), 1566–1575. https://doi.org/10.1016/j.apmr.2015.05.019

    • Search Google Scholar
    • Export Citation

  • Desharnais, R., Bouillon, J., & Godin, G. (1986). Self-efficacy and outcome expectations as determinants of exercise adherence. Psychological Reports, 59(3), 1155–1159. https://doi.org/10.2466/pr0.1986.59.3.1155

    • Search Google Scholar
    • Export Citation

  • Devillard, X., Rimaud, D., Roche, F., & Calmels, P. (2007). Effects of training programs for spinal cord injury. Annales de Réadaptation et de Médecine Physique, 50(6), 490–498. https://doi.org/10.1016/j.annrmp.2007.04.013

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Dullard, B. (2014). A comparison of general and task-specific measures of self-efficacy in adult hearing aid users [Doctoral dissertation, University of Connecticut]. https://opencommons.uconn.edu/cgi/viewcontent.cgi?article=6753&context=dissertations

    • Search Google Scholar
    • Export Citation

  • Foley, L., Prapavessis, H., Maddison, R., Burke, S., McGowan, E., & Gillanders, L. (2008). Predicting physical activity intention and behavior in school-age children. Pediatric Exercise Science, 20(3), 342–356. https://doi.org/10.1123/pes.20.3.342

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Fraley, R.C., & Vazire, S. (2014). The N-pact factor: Evaluating the quality of empirical journals with respect to sample size and statistical power. PLoS One, 9(10), Article e109019. https://doi.org/10.1371/journal.pone.0109019

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Gauthier, C., Brosseau, R., Hicks, A.L., & Gagnon, D.H. (2018). Feasibility, safety, and preliminary effectiveness of a home-based self-managed high-intensity interval training program offered to long-term manual wheelchair users. Rehabilitation Research and Practice, 2018, Article 8209360. https://doi.org/10.1155/2018/8209360

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Ginis, K.A.M., Arbour-Nicitopoulos, K.P., Latimer-Cheung, A.E., Buchholz, A.C., Bray, S.R., Craven, B.C., . . . Horrocks, J. (2012). Predictors of leisure time physical activity among people with spinal cord injury. Annals of Behavioral Medicine, 44(1), 104–118. https://doi.org/10.1007/s12160-012-9370-9

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Ginis, K.A.M., van der Scheer, J.W., Latimer-Cheung, A.E., Barrow, A., Bourne, C., Carruthers, P., . . . de Groot, S. (2018). Evidence-based scientific exercise guidelines for adults with spinal cord injury: An update and a new guideline. Spinal Cord, 56(4), 308–321. https://doi.org/10.1038/s41393-017-0017-3

    • Search Google Scholar
    • Export Citation

  • Gorgey, A.S. (2014). Exercise awareness and barriers after spinal cord injury. World Journal of Orthopedics, 5(3), 158–162. https://doi.org/10.5312/wjo.v5.i3.158

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Hoeks, J., & Schrauwen, P. (2012). Muscle mitochondria and insulin resistance: A human perspective. Trends in Endocrinology and Metabolism, 23(9), 444–450. https://doi.org/10.1016/j.tem.2012.05.007

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Hoekstra, S., Valent, L., Gobets, D., van der Woude, L., & de Groot, S. (2017). Effects of four-month handbike training under free-living conditions on physical fitness and health in wheelchair users. Disability and Rehabilitation, 39(16), 1581–1588. https://doi.org/10.1080/09638288.2016.1200677

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Jacobs, K.A., Burns, P., Kressler, J., & Nash, M.S. (2013). Heavy reliance on carbohydrate across a wide range of exercise intensities during voluntary arm ergometry in persons with paraplegia. The Journal of Spinal Cord Medicine, 36(5), 427–435. https://doi.org/10.1179/2045772313Y.0000000123

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Jung, M.E., Bourne, J.E., & Little, J.P. (2014). Where does HIT fit? An examination of the affective response to high-intensity intervals in comparison to continuous moderate-and continuous vigorous-intensity exercise in the exercise intensity-affect continuum. PLoS One, 9(12), Article e114541. https://doi.org/10.1371/journal.pone.0114541

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Jung, W.-S., Hwang, H., Kim, J., Park, H.-Y., & Lim, K. (2019). Comparison of excess post-exercise oxygen consumption of different exercises in normal weight obesity women. Journal of Exercise Nutrition & Biochemistry, 23(2), 22–27. https://doi.org/10.20463/jenb.2019.0013

    • Search Google Scholar
    • Export Citation

  • Jüni, P., Loke, Y., Pigott, T., Ramsay, C., Regidor, D., Rothstein, H., . . . Shea, B. (2016). Risk of bias in non-randomized studies of interventions (ROBINS-I): Detailed guidance. British Medical Journal, 355, Article i4919.

    • Search Google Scholar
    • Export Citation

  • Kehn, M., & Kroll, T. (2009). Staying physically active after spinal cord injury: A qualitative exploration of barriers and facilitators to exercise participation. BMC Public Health, 9(1), Article 168. https://doi.org/10.1186/1471-2458-9-168

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Kendzierski, D., & DeCarlo, K.J. (1991). Physical activity enjoyment scale: Two validation studies. Journal of Sport & Exercise Psychology, 13(1), 50–64. https://doi.org/10.1123/jsep.13.1.50

    • Search Google Scholar
    • Export Citation

  • King, A.C. (2001). The coming of age of behavioral research in physical activity. Annals of Behavioral Medicine, 23(4), 227–228. https://doi.org/10.1207/S15324796ABM2304_1

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Koontz, A.M., Garfunkel, C.E., Crytzer, T.M., Anthony, S.J., & Nindl, B.C. (2021). Feasibility, acceptability, and preliminary efficacy of a handcycling high-intensity interval training program for individuals with spinal cord injury. Spinal Cord, 59(1), 34–43. https://doi.org/10.1038/s41393-020-00548-7

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Kroll, T., Kratz, A., Kehn, M., Jensen, M.P., Groah, S., Ljungberg, I.H., . . . Bombardier, C. (2012). Perceived exercise self-efficacy as a predictor of exercise behavior in individuals aging with spinal cord injury. American Journal of Physical Medicine & Rehabilitation, 91(8), 640–651. https://doi.org/10.1097/PHM.0b013e31825a12cd

    • Search Google Scholar
    • Export Citation

  • Kruger, E.A., Pires, M., Ngann, Y., Sterling, M., & Rubayi, S. (2013). Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends. The Journal of Spinal Cord Medicine, 36(6), 572–585. https://doi.org/10.1179/2045772313Y.0000000093

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Kuipers, H., Verstappen, F.T., Keizer, H.A., Geurten, P., & van Kranenburg, G. (1985). Variability of aerobic performance in the laboratory and its physiologic correlates. International Journal of Sports Medicine, 6(4), 197–201. https://doi.org/10.1055/s-2008-1025839

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Lucas, C.P. (1992). The order effect: Reflections on the validity of multiple test presentations. Psychological Medicine, 22(1), 197–202. https://doi.org/10.1017/S0033291700032852

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Lunenburg, F.C. (2011). Goal-setting theory of motivation. International Journal of Management, Business, and Administration, 15(1), 1–6.

    • Search Google Scholar
    • Export Citation

  • MacInnis, M.J., & Gibala, M.J. (2017). Physiological adaptations to interval training and the role of exercise intensity. The Journal of Physiology, 595(9), 2915–2930. https://doi.org/10.1113/JP273196

    • PubMed
    • Search Google Scholar
    • Export Citation

  • McAuley, E. (1992). The role of efficacy cognitions in the prediction of exercise behavior in middle-aged adults. Journal of Behavioral Medicine, 15(1), 65–88. https://doi.org/10.1007/BF00848378

    • PubMed
    • Search Google Scholar
    • Export Citation

  • McAuley, E., Mullen, S.P., Szabo, A.N., White, S.M., Wójcicki, T.R., Mailey, E.L., . . . Erickson, K. (2011). Self-regulatory processes and exercise adherence in older adults: Executive function and self-efficacy effects. American Journal of Preventive Medicine, 41(3), 284–290. https://doi.org/10.1016/j.amepre.2011.04.014

    • PubMed
    • Search Google Scholar
    • Export Citation

  • McLeod, J.C., Diana, H., & Hicks, A.L. (2020). Sprint interval training versus moderate-intensity continuous training during inpatient rehabilitation after spinal cord injury: A randomized trial. Spinal Cord, 58(1), 106–115. https://doi.org/10.1038/s41393-019-0345-6

    • PubMed
    • Search Google Scholar
    • Export Citation

  • McMillan, D. (2020). Physiological responses to moderate intensity continuous and high-intensity interval exercise in persons with paraplegia. Spinal Cord, 59(1), 26–33. https://doi.org/10.1038/s41393-020-0520-9

    • PubMed
    • Search Google Scholar
    • Export Citation

  • McMillan, D.W., Astorino, T.A., Correa, M.A., Nash, M.S., & Gater, D.R. (2021). Virtual strategies for the broad delivery of high intensity exercise in persons with spinal cord injury: Ongoing studies and considerations for implementation. Frontiers in Sports and Active Living, 3, Article 703816. https://doi.org/10.3389/fspor.2021.703816

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Molmen-Hansen, H.E., Stolen, T., Tjonna, A.E., Aamot, I.L., Ekeberg, I.S., Tyldum, G.A., . . . Stoylen, A. (2012). Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. European Journal of Preventive Cardiology, 19(2), 151–160. https://doi.org/10.1177/1741826711400512

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Morris, K.S., McAuley, E., & Motl, R.W. (2008). Neighborhood satisfaction, functional limitations, and self-efficacy influences on physical activity in older women. International Journal of Behavioral Nutrition and Physical Activity, 5(1), Article 13. https://doi.org/10.1186/1479-5868-5-13

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Nightingale, T.E., Metcalfe, R.S., Vollaard, N.B., & Bilzon, J.L. (2017). Exercise guidelines to promote cardiometabolic health in spinal cord injured humans: Time to raise the intensity? Archives of Physical Medicine and Rehabilitation, 98(8), 1693–1704. https://doi.org/10.1016/j.apmr.2016.12.008

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Peters, J. (2022). The feasibility of a high intensity interval training-based handcycling activity in people with spinal cord injury [Doctoral dissertation]. University of Illinois at Urbana-Champaign.

    • Search Google Scholar
    • Export Citation

  • Peters, J., Abou, I, Dandeneau, K, Rice, L, & Rice, I. (2021). The effectiveness of vigorous training interventions on cardiovascular fitness in persons with spinal cord injury: A systematic review and meta-analysis. Spinal Cord, 59(10), 1035–1044. https://doi.org/10.1038/s41393-021-00669-7

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Poon, E.T., Sheridan, S., Chung, A.P., & Wong, S.H. (2018). Age-specific affective responses and self-efficacy to acute high-intensity interval training and continuous exercise in insufficiently active young and middle-aged men. Journal of Exercise Science and Fitness, 16(3), 106–111. https://doi.org/10.1016/j.jesf.2018.09.002

    • Search Google Scholar
    • Export Citation

  • Rognmo, Ø., Hetland, E., Helgerud, J., Hoff, J., & Slørdahl, S.A. (2004). High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. European Journal of Preventive Cardiology, 11(3), 216–222. https://doi.org/10.1097/01.hjr.0000131677.96762.0c

    • Search Google Scholar
    • Export Citation

  • Rognmo, O., Moholdt, T., Bakken, H., Hole, T., Molstad, P., Myhr, N.E., . . . Wisloff, U. (2012). Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation, 126(12), 1436–1440. https://doi.org/10.1161/CIRCULATIONAHA.112.123117

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Schoenmakers, P., Reed, K., Van Der Woude, L., & Hettinga, F.J. (2016). High intensity interval training in handcycling: The effects of a 7 week training intervention in able-bodied men. Frontiers in Physiology, 7, Article 638. https://doi.org/10.3389/fphys.2016.00638

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Snook, E.M., & Motl, R.W. (2008). Physical activity behaviors in individuals with multiple sclerosis: Roles of overall and specific symptoms, and self-efficacy. Journal of Pain and Symptom Management, 36(1), 46–53. https://doi.org/10.1016/j.jpainsymman.2007.09.007

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Subbarao, J.V., Klopfstein, J., & Turpin, R. (1995). Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury. The Journal of Spinal Cord Medicine, 18(1), 9–13. https://doi.org/10.1080/10790268.1995.11719374

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Theisen, D. (2012). Cardiovascular determinants of exercise capacity in the Paralympic athlete with spinal cord injury. Experimental Physiology, 97(3), 319–324. https://doi.org/10.1113/expphysiol.2011.063016

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Tsai, C.-Y., Rice, L.A., Hoelmer, C., Boninger, M.L., & Koontz, A.M. (2013). Basic psychometric properties of the transfer assessment instrument (version 3.0). Archives of Physical Medicine and Rehabilitation, 94(12), 2456–2464. https://doi.org/10.1016/j.apmr.2013.05.001

    • PubMed
    • Search Google Scholar
    • Export Citation

  • White, N.-H., & Black, N.-H. (2016). Spinal cord injury (SCI) facts and figures at a glance. National Spinal Cord Injury Statistical Center.

    • Search Google Scholar
    • Export Citation

  • Williams, D.M., Anderson, E.S., & Winett, R.A. (2005). A review of the outcome expectancy construct in physical activity research. Annals of Behavioral Medicine, 29(1), 70–79. https://doi.org/10.1207/s15324796abm2901_10

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Wójcicki, T.R., White, S.M., & McAuley, E. (2009). Assessing outcome expectations in older adults: The multidimensional outcome expectations for exercise scale. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 64(1), 33–40. https://doi.org/10.1093/geronb/gbn032

    • PubMed
    • Search Google Scholar
    • Export Citation

  • Yıldırım, K., & Şengel, K. (2004). Spinal kord yaralanmaları ve rehabilitasyonu [Spinal cord injury and rehabilitation]. Klinik Aktüel Tıp Dergisi, 4, 26–38.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 482 482 91
Full Text Views 1686 1686 80
PDF Downloads 63 63 11