Cessation of a 12-Month Body-Weight Supported Treadmill Training Program: Effect on Functional Ambulation and Health-Related Quality of Life in Individuals with Incomplete Spinal Cord Injury

Abstract

The purpose of this study was to determine the effects of cessation of a 12-month thrice-weekly body-weight supported treadmill training (BWSTT) program on functional ambulation and aspects of health-related quality of life (HRQL) in individuals with incomplete SCI. Twelve men and women (aged 22-55) with chronic (> 1 year post-injury) incomplete SCI (ASIA B or C) returned for follow-up (FOL) testing 37 weeks (SD 2.1) following their final scheduled BWSTT session. Functional ambulation was compared based on: i) required percentage of body-weight support (%BWS) on the treadmill, ii) preferred treadmill speed and iii) overground walking. Evaluation of HRQL included measures of: i) satisfaction with life, ii) perceived ability to perform activities of daily living (ADL), iii) perceptions of health, and iv) depressive symptomology. Participants were invited to participate in once-weekly BWSTT and twice-weekly fitness training during the FOL period (37 sessions); the actual number of BWSTT sessions attended was only 11.6 (range 0-29) and the total days of exercise was 29.1 (range 0-75). The 12-month BWSTT program resulted in a decrease in the required %BWS (73±10% to 19±12%; p<.01), an increase in treadmill speed (0.5±0.3 to 1.4±0.8 km/h; p<.01), improved overground walking in 4 individuals, and improved group satisfaction with life (p<.05). At FOL, %BWS increased to 35±14% (p<.01), but was still less than at pre-training (p<.01). There were no differences between 12-month and FOL scores on any HRQL-related measures. High exercise adherence during the FOL period had a strong correlation with a positive percent change in perceived ability to perform ADL (r = .70; p<.05), as well as non-significant trends with positive percent change in perceptions of health and negative percent change in depressive symptomology (r = .49; p=.13 and r = .51; p=.ll, respectively). Therefore, even with very limited access to the BWS treadmill, much of the improvement in treadmill walking ability and satisfaction with life following long-term BWSTT in individuals with incomplete SCI can be retained for at least 8 months. Continued exercise participation, however, may contribute to maintain or further improve aspects of HRQL in this population.