Feasibility, Safety, and Preliminary Effectiveness of a Home-Based Self-Managed High-Intensity Interval Training Program Offered to Long-Term Manual Wheelchair Users
Question
Is home-based self-managed manual wheelchair HIIT feasible, safe, and preliminarily effective compared with moderate continuous wheelchair training in long-term manual wheelchair users with spinal cord injury?
Summary
A 6-week home-based manual wheelchair HIIT program was feasible for long-term wheelchair users with spinal cord injury, but shoulder pain was an important safety concern. Fitness and upper-limb strength did not significantly improve in this very small pilot sample.
Methodology
- Community-dwelling long-term manual wheelchair users with spinal cord injury
- 11 participants.
- Self-managed manual wheelchair propulsion.
- Work intervals: 30 s high-intensity propulsion.
- Recovery: 60 s low-intensity propulsion.
- Intensity: High intervals Borg CR10 RPE 6-8; low intervals RPE 1-2.
- 40 min.
- 3 sessions/week.
- 6 weeks.
- Exploratory randomized controlled open-label pilot trial
- Feasibility, Safety, VO2peak, and Upper-limb strength were tracked.
Outcomes
Feasibility
Both home-based training programs were rated feasible and acceptable.
Compliance HIIT 86.11%; MICT 97.78%; all participants completed at least 75% of planned sessions
Dropout
HIIT had higher dropout than MICT in this small pilot.
HIIT dropout 33%; MICT dropout 0%
Shoulder pain
Shoulder pain increased in several HIIT participants and caused one dropout.
One dropout +19.2/150 WUSPI after 6 sessions; two completers +10.0/150 and +5.3/150
Fitness
Neither group had significant group-level cardiorespiratory fitness improvement.
No significant within-group or between-group VO2peak changes
Strength
Upper-limb strength did not significantly improve overall.
No significant between-group relative differences except shoulder external rotation strength p = 0.016
Insights
- Home wheelchair HIIT can be feasible with weekly clinician calls and route planning.
- Shoulder pain screening and prevention are central for wheelchair HIIT.
- Safe routes with slopes or higher rolling resistance may be needed to reach intensity without unsafe speed.
Limitations
- Very small pilot sample
- Most participants already physically active
- No non-exercise control group
- Exercise intensity self-managed by RPE
- Usual physical activity differed between participants
Safety
- No severe adverse events occurred, but one HIIT participant stopped because of shoulder pain and two HIIT completers had clinically meaningful WUSPI increases.