Development of a wheelchair exercise training program for persons with multiple sclerosis using a community-engaged research approach

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Project Summary The objective of this postdoctoral fellowship application (F32) is to accelerate Dr. Silveira’s development as an independent scientist and advance the current knowledge and resources for health promotion through exercise training in persons with multiple sclerosis (MS) who use wheelchairs. Approximately 1 million Americans are currently living with MS. Physical activity research in persons with MS has overwhelmingly focused on persons who are ambulatory, though up to 32% of the MS population has a more progressed disease course that requires full or part-time use of a wheelchair. This segment of the MS population may require structured exercise training programs based on the presence of significant barriers associated with engaging in lifestyle physical activity, including community accessibility, cost, and weather. There are currently no widely available exercise training programs for this segment of the MS population. Exercise training programs are critical for promoting wellness and independence and have the potential for reducing long-term health-care costs (e.g., medications for CVD & diabetes) among persons living with MS. The proposed study leverages preliminary qualitative inquiry conducted by Dr. Silveira regarding preferences for an exercise training program among persons with MS living across the United States who use wheelchairs. Dr. Silveira is uniquely suited to lead the proposed research due to prior training in adapting health promotion curriculum and mentorship available in the training environment that promote successful completion of training goals and specific aims. Dr. Silveira will work with leading experts in adaptive exercise and create a novel exercise program that meets the needs of persons with MS who use wheelchairs (Aim 1). These products will be informed by preliminary data, current pragmatic clinical trial materials, and modified using community- engaged research approach by requesting critical feedback from community advisors with MS (Aim 2). This study serves several roles in exceling Dr. Silveira toward the ultimate goal of becoming an independent applied rehabilitation researcher by providing directed training and experience in curriculum development, project management, and clinical trials. The Sponsor (Prof. Robert Motl) is Professor of Physical Therapy and the Associate Director of Research at the UAB/Lakeshore Research Collaborative, and will provide the expertise necessary for guiding the successful completion of the proposed aims. The Sponsor further has an extensive record of training successful independent scientists in academic settings. The Co- Sponsor (Prof. James Rimmer) is an expert in exercise adaptations for persons with mobility impairments and has established a record of success in creating and implementing exercise programs. The proposed study includes a comprehensive training plan with regularly scheduled meetings, educational courses, direct experiences, and workshops on clinical trial methodology, behavior change theory, and exercise medicine.