Development of a socially connected exercise system for wheelchair users

Veterans who use wheelchairs are often prescribed physical activity (PA) in an effort to manage weight and improve cardiovascular health and function however few wheelchair users are currently meeting the recommended amounts of moderate to vigorous aerobic activity (3 times per week ~30 minutes per session). There are many barriers to achieving ample PA including lack of transportation to PA facilities and programs, social support, motivation and access to accessible fitness equipment and knowledgeable trainers. An accessible, motivating, socially supported, and effective exercise option that wheelchair users can participate in from home could help mitigate these barriers to engaging in routine PA. With the onset of the pandemic came a wealth of home-based smart connected exercise devices and fitness apps that enable for interactive video based instruction, virtual/augmented reality world exercise experiences, and integrated social networking features (e.g. group exercise, leaderboards) for the able-bodied market. These applications have been found to improve intrinsic motivation through social support and enjoyment in addition to PA levels and performance. However, these technologies are largely exclusive of persons with disabilities due to the inability to use the connected fitness equipment. Current upper-arm ergometers have limited internet connectivity. Handcycles can be adapted to smart connected bike trainers for use in the home but they require a customized set up that requires a difficult transfer and a lot of space. Therefore, we propose to develop a home-based, smart connected upper-arm ergometer that would enable wheelchairs users to more easily and effectively participate in video and virtual reality-based fitness apps that have social components and motivational features. The specific aims of this study are: 1) to iteratively develop a prototype home-based, smart connected upper-arm cycling trainer (ParaCycle) 2) verify the functionality of the ParaCycle through in lab testing with wheelchair users; and 3) conduct a 6-week in-home pilot study with the refined ParaCycle prototype to evaluate its functionality, safety, utility and device satisfaction. For Aim 1, we will develop ParaCycle in accordance with engineering standards related to the manufacturing of connected fitness equipment and involving end users and stakeholders in the design review process. In Aim 2, 15 wheelchair users will be tested on the setup and use of the device (>68 on the System Usability Scale), the ability of ParaCycle to elicit moderate to high intensity exercise (average session power between 76% and 87% functional threshold power), and a high level of enjoyment (Physical Activity Enjoyment Scale > 100). For Aim 3, a 6-week in-home study will be conducted with 10 wheelchair users to assess functionality (e.g. ability to maintain continuous communication with the fitness apps and remotely transmit fitness data); safety (e.g. adverse events as a result of device use) and utility (e.g. how often the device is used) and level of satisfaction.